Individual
TIMOTHY MICHAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
982 DRAYTON AVENUE, ELBA, AL 36323
(334) 897-3418
(334) 897-3438
Mailing address
PO BOX 450, ELBA, AL 36323
(334) 897-3418
(334) 897-3438
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4025
AL
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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